4 days old

Supervisor Medical Claim Review Healthcare WellMed San Antonio TX

San Antonio, TX 78205
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  • Job Code
    874278

Do you have compassion and a passion to help others? Transforming healthcare and millions of lives as a result starts with the values you embrace and the passion you bring to achieve your life's best work.(sm) 


Under the supervision of the Vice President of Utilization Management, the supervisor is responsible for the daily operations of the UM department. Daily coordination with Medical Directors, UM Nurses, UM Coordinators, provider network and other various PHC departments and staff to deliver cost effective, quality of care services to PHC members, in accordance with PHC's policies and processes. Provides administrative and leadership support to staff.

 

Primary Responsibilities:

  • Performs daily oversight of the UM phone queue to meet established performance metrics.
  • Oversees prior authorization inventory and regulatory timeframes.
  • Responsible for supervising all aspects of the UM claim review inventory and service timeframes.
  • Assists with the hiring and training of new staff as needed.
  • Applies employee performance management techniques through job-related coaching, training and development activities.
  • Conducts routine audits on UM reviews to ensure adherence to CMS regulations.
  • Produces daily, weekly and monthly UM reports.
  • Conducts routine staff meetings.
  • Conducts provider education sessions on PHC UM processes.
  • Performs all other related duties as assigned.
This is an office based position near Northwest Parkway, 78249 / Da Zavala and IH-10E


The big challenge is motivating people and leading by example with a positive attitude that's professional, courteous and cheerful.


You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

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Posted: 2020-05-20 Expires: 2020-06-19

UnitedHealth Group is the most diversified health care company in the United States and a leader worldwide in helping people live healthier lives and helping to make the health system work better for everyone.

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Supervisor Medical Claim Review Healthcare WellMed San Antonio TX

UnitedHealth Group
San Antonio, TX 78205

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